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NPI Code Detail

MEDICARE: BRIDGET MARIE WICKS FNP

MEDICARE: BRIDGET MARIE WICKS FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerCOA.08958-NPOH

General Provider Information

NPI Number : 1194838284
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIDGET MARIE WICKS FNP
Provider Business Mailing Address
First Line : 2920 N 4TH ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-1816
Country : US
Telephone Number : 928-213-6100
Fax Number :
Provider Business Practice Location Address
First Line : 2187 N VICKEY ST STE 2
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-6121
Country : US
Telephone Number : 928-527-1899
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 04/18/2019

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Directions to “ BRIDGET MARIE WICKS FNP” Practice Location

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